Impact of using Computerized Physician Order Entry in Saudi Arabia

Computerized Physician Order Entry (CPOE) is a process which allows direct entry of medical orders by the health care decision makers. It gained prominence again after the publication of two reports by the Committee on Quality on Health Care in America on medical errors and improvement of the quality of the health system (Kohn et al. , 2000; Committee on Quality of Health Care in America, 2001). The committee suggests that the wide introduction of CPOE would reduce the number of medical errors significantly and that therefore CPOE would improve the quality of care and patient outcomes.

Indeed, it has been shown to be effective in improving patient care. A team of researchers at Oregon Health and Science University the Physician Order Entry Team (POET), began conducting studies in 1997. Evidences suggest that Computerized Physician Order Entry can improve patient safety in both hospital and ambulatory environments (Bates, Cohen et al. , 2001; Bates, Leape et al. , 1998; Bates, Teich et al. , 1999; King et al. , 2004; Berger and Kichak, 2004; Overhage, and Tierney et al. , 1997). Unsurprisingly, then, interest in CPOE increased greatly when the Institute of Medicine (IOM) (Corrigan et al.

, 1999) reported that between 44,000 and 98,000 people die from medical errors in U. S. hospitals each year. The Leapfrog Group has made installing CPOE in hospitals one of its recommendations (Berkmeyer and Dimick, 2004). One measure of patient safety is the incidence of adverse drug events (ADEs). These are injuries resulting in a medical intervention related to a drug (Bates, Boyle et al, 1995). From their studies, they described how they estimated the effects of using CPOE in hospitals and physician practices nationwide to avoid both inpatient and ambulatory ADEs.

In addition, they were able to estimate some benefits of ambulatory CPOE that are not related to ADE avoidance. When a hospital or a physician’s practice implements CPOE, physicians stop writing orders by hand on pieces of paper and start entering them electronically into a computer system. But much more than order-writing is going on. First, the CPOE makes information available to the physician at the time he or she enters the order. If the physician is writing a medication order, for example, the CPOE may present a list of drugs that the patient is already taking and warn of any interactions those drugs may have with the drug being ordered.

The CPOE may display the patient’s most recent laboratory results. It can check the dose against dosage standards. Once the order has been entered, the system can track the steps involved in executing the order, providing a mechanism for identifying and eliminating errors. In the longer term, it provides the information needed to redesign the order-execution process so that making errors becomes much more difficult. To provide these benefits, the CPOE must include decision support and it must have access to current patient-specific information, in effect, an Electronic Medical Record (EMR).

Thus, when we speak of CPOE, we mean the capability of a more comprehensive health information system. Today, the main focus is the implementation of the computerized physician order entry system. This system allows the creation and maintenance of pre-configured physician order sets that are designed to speed up the ordering process. There are 8 to 10 vendors in today’s market who offer CPOE solutions. It is important for a health care enterprise to choose the appropriate vendor solution because CPOE is at the beginning of the EPR implementation process.

It is critical to ensure that the CPOE can be integrated with other EPR modules, such as clinical documentation, pharmacy and laboratory. CPOE solutions today offer real-time decision support tools such as appropriateness of the order, ordering process, drug interaction and contra-indication prompts, advisory messages on limits, patient clinical and demographic information, dose calculations, industry standard drug reference database, and the capability to perform edits in real time. The decision making tool is a rules-based engine that can be activated, built on, and modified by the health care enterprise.

In operation, the CPOE module is linked with other applications and databases that provide the necessary patient information (Dryo, 2004). Implementing such a clinical information system is not merely an information technology (IT) project. It is an organizational-change initiative. As suggested by the comments above on order-execution tracking, the organization should anticipate that changes can take place mostly within existing organizations. If a hospital installs CPOE, the value of CPOE can be realized by changing processes (such as the medication-administration process) within the hospital.

It is not necessary that activities in the hospital be any better coordinated with activities at physician’s offices than they are now. On the contrary, the implementation of CPOE has been fraught with problems. Massaro described how residents in the University of Virginia Medical Center opposed the implementation of CPOE because will be required to use it and complained that in only 15% of the hospitals that had implemented CPO physicians were using it. In addition to this, the implementation of CPOE has been fraught with problems.

Massaro et al. , (2003) described how residents in the University of Virginia Medical Center opposed the implementation of CPOE because will be required to use it and complained that in only 15% of the hospitals that had implemented CPO physicians were using it. The first, a survey study to discover what percent of U. S. hospitals have Computerized Physician Order Entry, found that there is a reported low usage of Computerized Physician Order Entry, of less than one third (Ash, Sittig et al. , 2003).

In a recent study of physician and public response to the medical error debate, Blendon et al. (2002), found that physicians do not see themselves as part of the problem and that they were less likely to adopt systemic approaches such as the use of information technology to reduce medical errors. As such, the most interesting question is not why the introduction of CPOE failed in one hospital or did not in the other, but whether and under what conditions CPOE can be implemented and appropriately used. In the studies conducted by Fieschi et al.

(2004), it was found out that the outcome of the implementation of CPOE in both hospitals was actually a thin line between failure and success. In both hospitals physicians were objecting CPOE. For the nurses and clerks in hospital B, it meant an improvement of the quality of medical orders (legibility, reduction of errors) that they were doing anyway for the doctors. Both hospitals held the opinion that it was only legal and natural that medical orders would be initiated by physicians, and could not be delegated to other professionals.

In both hospitals implementing CPOE was therefore not seen and planned for as organizational change. “Technical” improvements were highlighted; the issue how medical work would or should change and the impact of CPOE’s use were not addressed. The researcher, intrigued by the relevant literature, endeavored next to discover the impact of using Computerized Physician Order Entry in Saudi Arabia. As such, the researcher hopes to gain insight with regards to the reduction of possible problems in the use of Computerized Physician Order Entry.